Isle of Wight NHS Trust

Updated 23 September 2021

The Isle of Wight NHS Trust is the only integrated acute, community, mental health and ambulance health care provider in England. Established in April 2012, the trust provides a full range of health services to an island population of about 143,000 people.

Overall, the trust provides 23 core services for acute, community, mental health and ambulance services.

Acute services are based at St Mary’s Hospital Newport with 245 beds. Services include emergency department, urgent care service (by referral only), emergency medicine and surgery, planned surgery, intensive care, paediatric services, a special care baby unit (SCBU), and maternity care services. Along with diagnostic and screening, pathology and pharmaceutical and outpatient services.

The community division provides a variety of supported care services within patients' homes, community settings, GP practices and clinics, as well as providing physiotherapy, occupational therapy and podiatry support within the acute setting. The community clinical provision is based in three localities of the Isle of Wight: Northeast, West and Central, and South Wight, with district nursing provision in each area. There is also support offered for children and young people through the paediatric therapy, occupational therapy, physiotherapy and speech and language therapy services.

The mental health division provides community learning disability services; inpatient and community based mental health care. With 32 beds for working age and older adults, supported by a home treatment team and a community mental health team for adults and child and adolescent mental health services.

The ambulance service division includes operational delivery units for the 999 emergency ambulances, NHS111 and patient transport services based at the St Mary's Hospital site.

We carried out this announced inspection of a range of the mental health, acute and community services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We did not inspect ambulance service division on this occasion. At our last inspection we rated the trust overall as requires improvement and remained in quality special measures. No use of resources review was carried-out for this inspection.

We inspected the following core services and rated them individually for the five key questions of safe, effective, caring responsive and well led. We also inspected the well-led key question for the trust overall. We rated 11 out of 11 services inspected as good.

At this inspection, overall, we rated safe, effective, caring, responsive, and well-led as 'good'. Our separate rating of well-led for the trust was good.

Acute

Diagnostic Imaging: all five key questions were rated good. Good overall

Medical Services: all five key questions were rated good. Good overall

Surgical Services: safe, effective responsive and well led were rated good, with caring rated as outstanding. Good overall

Gynaecology Services: safe, effective, caring and responsive were rated good and well led rated was rated requires improvement. Good overall

Children and Young People: all five key questions were rated good. Good overall

Mental Health

Acute wards for adults of working age and psychiatric intensive care units: Effective, caring, responsive and well led rated good with safe rated as requires improvement. Good overall

Wards for older people with mental health problems: all five key questions rated good. Good overall

Community based mental health services of adults of working age: safe, effective, caring and well led rated good with responsive rated as requires improvement. Good overall

Mental health crisis services and health-based places of safety: effective, caring, response and well led rated as good with safe rated as requires improvement. Good overall

Community

Community adults: safe, effective, responsive and well led rated as good with caring rated as outstanding. Good overall

Community inpatients services: safe, effective, responsive and well led rated as good with caring rated as outstanding. Good overall

On this occasion, we did not inspect the ambulance service division. In rating the trust, we took into account the current ratings of the 11 core services we did not inspect this time but had rated previously.

Our rating of well led improved. We rated them as good because:

The trust leadership demonstrated the delivery of improvement plans over time and had plans for a strategy refresh to progress the quality of care delivery for the future.

There was a clear vision for now and the future of healthcare on the island.

Across the trust teams were determined to meet the needs of patients and the public.

The executive team showed the drive to make the trust a better place for staff to work in.

Staff were mostly satisfied with working at the trust which was the island’s main employer.

Staff were able to directly influence the quality of services and make changes in their own areas.

There were quality improvement objectives and audits to identify progress and next steps.

Recruitment internally and externally, including from overseas, had benefited the trust services.

Engagement with staff, patients, partners and the system were much improved and were effective.

New approaches for communication were introduced and there was renewed vigour to continually improve the communication for patients and their relatives.

There were established systems and partnership working for the sustainability of the organisation which was for the benefit of the population of the Isle of Wight.

The partnership links were contributing to the success of supporting patients to have good care and treatment on the island.

The culture, enthusiasm and energy for the quality of patient care showed significant improvement.

There was a greater patient focus than seen before.

There was established support for staff care and wellbeing as confirmed by the improved staff survey outcomes and as seen throughout all areas inspected.

The strategy for equality and inclusion was far more developed and was working towards meeting the needs of people with protected characteristics.

There was a developing research team and projects underway.

However:

Delays in mandatory training delivery, such as for safeguarding and resuscitation, could impact on patient care.

The trust had identified information technology systems needed new investment, the continued delays affected the cohesiveness and modernisation of the trust’s information management.

The trust’s non-executive directors lacked visibility in some services which had previously been identified before the pandemic restrictions.

Recruitment to some key roles was filled on an interim, fixed term or locum basis reducing the stability of the trust.

The trust application of the equality and inclusion strategy across the range of staff and patient protected characteristics was better in some departments than others.

The referral to treatment times waiting lists, both pre- and post-pandemic, remained a challenge for the trust.

The fit and proper person checks for directors were not always completed in a timely way.

There needed continued investment in the estate to ensure appropriate care and support was provided to all patient groups.

How we carried out the inspection

During the core service inspection, we visited the location and sites for the 11 core services inspected, and we spoke to a range of staff, patients and key stakeholders. We also inspected the well-led key question for the trust overall. We conducted well-led interviews remotely.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 4 September 2019

Updated 4 September 2019

Updated 6 July 2026

We carried out an assessment of the emergency operations centre on 24 and 25 February 2026.

An emergency operations centre for an ambulance service is the centralised control hub where 999 emergency calls are received, triaged, and dispatched. The emergency operations centre was known as the Clinical Coordination Centre by the trust and is referred to as the Clinical Coordination Centre (CCC) throughout this report. It was staffed by call handlers, known as health advisors by the trust, senior health advisors, clinical advisors (nurses and paramedics), and dispatchers. The ambulance service medical lead, who is both an ED Consultant and a pre-hospital emergency medical (PHEM) doctor, and critical care paramedics were also located in the Clinical Coordination Centre.

The service had made improvements since our last inspection. We rated the service as good.

Staff followed systems and process to facilitate safe care and treatment to patients in a timely manner. Staff treated patients with kindness and empathy, and they acted to protect patients’ dignity. The service worked collaboratively with the acute service in the trust and with partner organisations to make improvements. The service had a focus on identifying and addressing inequalities to care and treatment.

Updated 6 July 2026

We carried out an assessment of patient transport services on 24 and 25 February 2026. We rated the service as good. The service had made improvements and is no longer in breach of regulations. Staff now assessed and mitigated the risks in relation to infection prevention and control, and processes were in place to monitor the quality of the service delivered. The patient transport service provided safe, effective and person-centred care, with clear systems and processes to support the timely coordination of patient journeys. Staff worked together with hospital teams, system partners and community services to maintain patient flow, reduce delays and support timely discharges. Managers demonstrated a good understanding of the local population, including the challenges associated with an island-based service, and worked with partners to maintain continuity of care. The service was flexible in responding to demand and used forward planning and shared oversight to manage capacity and reduce risks. Staff treated patients with dignity and compassion, adapting care to meet individual needs, including those requiring additional support. Communication with patients and partners was effective, helping to ensure safe, coordinated transfers across the healthcare system. Overall, the service was well organised and responsive, with a strong focus on partnership working, service improvement and delivering positive outcomes for patients.

Updated 6 July 2026

The Isle of Wight Ambulance Service (IOWAS) is part of Isle of Wight NHS Trust. The emergency and urgent care service (EUC) for IOWAS has one ambulance station which is located on the site of St. Mary’s Hospital in Newport. There are multiple identified standby points across the island to support dynamic deployment, however Ryde and Shanklin fire stations provide crew rest and welfare facilities for when they are on standby in these areas.

We carried out this assessment of Emergency and Care (EUC) services from 24 to 25 February 2026. At our previous inspection in 2019 we rated the service good overall and in safe, effective, caring and responsive. We rated them as requires improvement for well led. At this assessment the overall rating remains good, and we rated them good in all key questions.

During our inspection, we spoke with 38 staff within the emergency and urgent care service, inspected vehicles, reviewed 14 patient records, and observed episodes of care. The staff we spoke with included frontline ambulance crews including paramedics and emergency care assistants. We spoke with the resourcing team, clinical support officers, operation station managers, fleet managers, volunteer manager, driving standards staff, specialist paramedics for urgent and emergency care and critical care paramedics, and clinical, education, quality and service leads.

Updated 23 September 2021

Updated 4 September 2019

Our rating of this service improved. We rated it as good because:

• We noted positive changes since our last inspection in January 2018.
• There was openness and transparency about safety, and continual learning was encouraged. Staff were supported to report incidents, including near misses.
• Staff were clear about their safeguarding responsibilities and if there was a concern about a child’s wellbeing safeguarding procedures were followed and understood. All staff we spoke with had completed the appropriate level of training in safeguarding.
• Care was planned and delivered in line with evidence-based guidance, standards and best practice and the individual needs of the child and family were met through the careful care planning.
• Staff received annual appraisals and new staff were supported when completing their competency assessments, helping to maintain and further develop their skills and experience.
• There was good multidisciplinary team working evident across the service including working with external agencies.
• Parents and children gave feedback about the care and kindness received from staff, which was positive. All the children and their carers we spoke with were happy with the care and support provided by staff. We observed staff treated children, young people and their families with compassion, kindness, dignity and respect. Staff worked in partnership with children, young people and families in their care.
• Guidance on how to make a complaint was readily available across the community children and young people’s service and was on the trust’s website.
• Managers at local levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
• In general staff gave clear advice in line with national guidance on health promotion.

However:

• The service did not always have oversight of medicines management.
• Some environments were not, in their design, child friendly and the service had not adapted them to meet the needs of the child and young person. However, patient’s privacy and confidentiality was not always maintained in the sexual In two areas of the service, staff did not consistently perform daily checks of a resuscitation trolley and a grab bag as per trust policy.
• The services IT systems did not all alert staff if a child, young person or family were on a child protection plan or if there was a risk to practitioners for home visiting. Therapy staff did not always complete a safeguarding assessment when meeting a child, young person or family.
• The 0-19 service did not have standardised protocols for recording visits on the electronic records system to ensure consistency across the service.
• Staff did not always provide advice to children, young people and their families based on national guidance for bottle feeding.

Updated 23 September 2021

Updated 6 June 2018

Our rating of this service improved. We rated it as good because:

• Staff had access to up to date, accurate and comprehensive information about children and young people in their care and treatment plans. They ensured that care plans and crisis plans were up to date and comprehensive, assisting the teams’ deliver of safe care and treatment to young people. Staff members ensured there was an effective system in place to assess the risks to all young people
• The staff team had reviewed and improved the way they reported incidents. They ensured incidents were consistently reported and there was learning from each incident.
• Staff involved children and young people and those close to them in decisions about their care and treatment. Children and young people spoken with were very positive about the care and treatment they received. The team listened to feedback from parents and young people, supported them and made changes because of the feedback.
• There was no waiting list for the service and young people were seen quickly.
• Staff were well trained to carry out their roles. There was suitably skilled and experienced staff to support children and young people’s needs.
• The manager promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff morale was good and staff felt positive about their team.

However:

• Young people could not always access the service when they needed it. There was no out of hours provision for young people. Young people admitted to hospital at the weekend had to wait until the following Monday before being assessed by CAMHS staff.
• The service did not deliver all the psychological therapies recommended by NICE.
• There was no provision for young people with attention deficit hyperactivity disorder or autism spectrum disorder. Whilst there were discussions with the clinical commissioning group about the pathway, these young people were excluded from the service and had been for several years.
• The service did not ensure that the premises were safe for children and young people. They had access to domestic knives in the unlocked kitchen.
• The manager did not ensure staff were competent for their roles because staff members did not all receive sufficient regular one to one managerial supervision.
• The staff team did not treat all complaints seriously because they did not investigate verbal complaints from children, young people or their families.

Updated 6 June 2018

Our rating of this service stayed the same. We rated it as good because:

• There was evidence that the waiting list was monitored and patients were assessed and prioritised according to risk. Staff could see Service users quickly if there were any concerns about any deterioration in their presentation.
• Staff delivered a range of evidenced based care and treatment interventions that were suitable for people with a learning disability. Care plans were personalised, holistic and considered the service user’s needs.
• Staff discussed risk in multi-disciplinary team (MDT) meetings and responded promptly to the service users need. Risk assessments were individual to each service user.
• Staff demonstrated a clear focus on service users physical health needs and considered its impact in their interventions in all records reviewed
• All staff had received an annual appraisal. Staff appraisals included conversations about career development and how it could be supported.
• Service users we spoke with said that staff treated them with dignity and respect and understood their care needs. Staff involved families and carers to understand service users likes, dislikes and specific needs where appropriate. All service users and carers reported feeling involved in their care.
• All areas were clean with good furnishings.

However:

• Service users were not having standardised risk assessments completed. A clear picture of a service users risks was not immediately apparent in the electronic notes. Information was not easily accessible on the electronic records system and was stored in different areas. Clinical information about the service user was difficult to find.
• Regular management supervision which included caseload supervision was not formally documented. Management supervision was not completed monthly in line with the trust supervision policy.
• Mental Health Act (MHA) specific training was not provided.
• Staff had not been involved with the transformation plan. Staff reported feeling out of the loop and did not know what was happening.
• Conflicts between staff were not managed quickly by senior managers
• The service was not taking positive action to support the national Transforming Care programme

Updated 23 September 2021

Updated 23 September 2021

Updated 23 September 2021

Updated 12 April 2017

We rated this service as good because.

• The building was accessible, with a clean and well-maintained environment. The clinic room contained appropriate equipment for physical health monitoring; for example, there was a couch and an electrocardiogram machine to check clients’ heart rhythm and electrical activity.
• There were sufficient numbers of staff to meet the needs and safety of the clients using the service. The trust provided all staff with mandatory training. There was a robust staff induction programme and staff attended mandatory training. Staff morale was good despite recent pressures of redesign and reductions in staffing.
• Staff interacted with clients in a respectful and supportive way. Staff were warm, kind, respectful, enthusiastic and positive. Full risk assessments and risk management plans were in place. They were clear and comprehensive. Staff discussed risk with partner agencies on an ongoing basis. Staff used a robust assessment tool called ‘client evaluation of self’ at the point of referral. All the care records we reviewed were comprehensive and clear. Staff assessed the physical and mental health of the clients and continued to review and update the records. Where appropriate, staff involved clients and family members fully in care planning.

• Staff supported clients in line with ‘drug misuse and dependence: UK guidelines on clinical management (2007)’ during detoxification treatment, and followed the trust’s ‘operational guidelines for alcohol and opioid prescribing’ as well as the Royal College of General Practitioners guidelines (first edition 2011). All the guidelines for interventions and prescribing pathways were adapted from appropriate National Institute of Clinical Excellence (NICE) guidelines. Prescribers recorded appointments and outcomes on the electronic records and a client’s prescribing pathway was clear and legible.

• There was a good choice of activities to suit individual needs such as the 12-step programme, and informal group sessions designed to help clients discuss and improve skills in coping with dependency and avoiding relapse, although the service did not have access to a psychologist

• The provider had a robust incident reporting process. Staff knew how to report incidents. Staff were open and honest when things went wrong.

However,

• Although the service had a detailed health and safety environmental risk assessment, including fire risk assessments, and staff told us their policy was to review the document annually, the environmental risk assessment had not been updated since January 2015 and staff had not monitored progress against the identified actions. Staff had also not updated all other policies, including for children visiting the service.

• Although supervision took place, this was not regular and documentation was of poor quality.

• Staff did not formally document a daily handover of client information at the end of each shift, which meant staff did not evidence how they monitored client progress.

• Staff did not have a clear system in place for documenting when they administered medication

• The service operated in isolation from the rest of the trust and staff did not feel the service was an integral part of the trust.

Updated 23 September 2021

Updated 9 September 2014

There were effective procedures for staff and people using the service, to report both low-level and serious incidents. These were reported to relevant agencies, investigated, and reviewed to prevent a reoccurrence. Staff had access to training to safeguard vulnerable adults, and some staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Mental Health Act (1983) was applied appropriately, and all documentation was current and in line with the Mental Health Act Code of Practice.

People were assessed and treated according to nationally-recognised pathways of care, and their health needs were being addressed. People were provided with psychological therapy, such as cognitive behaviour therapy (CBT). Staff and managers had regular supervision and appraisal, and new and temporary staff had induction. Staff worked in multidisciplinary teams to co-ordinate care, and were involved in goal setting and regular audits of care plans, but the use of outcome measures of effectiveness was not routine.

People were involved in their care and treatment; there was information on independent mental capacity advocates, and independent mental health advocates were available should people wish to talk with them.

There was a clear vision and strategy for the service; however, the unit did not have a clear understanding of the trust’s overall vision and strategies, and staff felt disconnected from the wider trust.